Effective primary care attenuates the association between frailty and hospital admission in old age: the ELSI-Brazil.

BACKGROUND: Frailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission. METHODS: This cross-sectional study included data from the second wave of the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, conducted in 2019-2021. Self-reported hospital admission in the past 12 months was the outcome. Frailty included the 5 phenotypic criteria: weight loss, exhaustion, low physical activity, weakness, and slowness. The effective primary care index included 12 attributes indicators, continuously. Statistical analyzes comprised logistic regression. RESULTS: Among the 7,436 study participants, frailty (odds ratio [OR] 2.17; 95% confidence intervals [95% CI] 1.31-3.62) and effective primary care index (OR 1.10; 95% CI 1.03-1.16) were positively associated with higher hospitalization. Interaction revealed that while effective primary care was positively associated with hospitalization, this association was different among frail older adults (OR 0.80; 95% CI 0.65-0.99). After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. The predicted probability of hospitalization tended to decrease along with higher primary care index values among frail older adults and became similar to prefrail/nonfrail at the highest end of the scale. CONCLUSIONS: Effective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.

Frailty is a multidimensional syndrome leading to a higher hospitalization. However, few studies explicitly analyze whether measures of effective primary care modify the relationship between frailty and hospital admission. Using data from the Brazilian Longitudinal Study of Aging (ELSI-Brazil), a representative community-based study with older adults aged 50 years and over, we evaluated self-reported hospital admission in the past 12 months, frailty according to 5 phenotypic criteria, and an effective primary care index with 12 attributes indicators. According to data of 7,436 study participants, we revealed that while effective primary care index was positively associated with hospital admission, this association was different among frail older adults. After stratification by frailty status, positive association with hospitalization remained only among prefrail and nonfrail individuals. Therefore, effective primary care decreases the likelihood of hospital admission among frail older adults. Interventions for delaying frailty should be initiated in primary care along with policies to strengthen primary care's organizational and provider/team-level attributes.

Chronic pain is associated with increased health care use among community-dwelling older adults in Brazil: the Pain in the Elderly (PAINEL) Study.

BACKGROUND: Chronic pain is known to increase health care use in high-income countries, but in Brazil, little is known. OBJECTIVE: To investigate the association between chronic pain and health care use among Brazilian older adults and explore the relationship between pain severity and health care use. METHODS: This cross-sectional study was derived from the population-based study Frailty in Brazilian Older People-FIBRA. Chronic pain, pain intensity and pain-related disability were assessed through additional telephone interviews. Health care use was measured by the number of doctor visits, hospitalization events and high health care use (highest quartile of the distribution for number of doctor visits) in the last 12 months. Associations were tested in regression analyses adjusted for predisposing, enabling and illness-level components from the Andersen Model. RESULTS: The 383 participants were predominantly female (71.0%), mean age was 75.6 (6.1 SD). The prevalence of chronic pain was 30.0%. Chronic pain was associated with number of doctor visits [unstandardized B coefficient 1.48; 95% confidence interval (CI) = 0.35-2.62] and high health care use [odds ratios (OR) = 2.27; 95% CI = 1.39-3.72]. Pain intensity was associated with high health care use in univariate (OR = 1.13; 95% CI = 1.06-1.20) but not multivariate analysis (OR = 1.12; 95% CI = 0.94-1.33). Pain-related disability was not associated with any outcome. CONCLUSION: Chronic pain increased health care use among Brazilian older adults. Improving the quality of primary care management of individuals at greater risk of chronic pain should be a cornerstone of health policies directed towards reducing the personal and societal burden of ageing.

Correlates of a Recent History of Disabling Low Back Pain in Community-dwelling Older Persons: The Pain in the Elderly (PAINEL) Study.

OBJECTIVES: To investigate the correlates of a recent history of disabling low back pain (LBP) in older persons. MATERIALS AND METHODS: The Pain in the Elderly (PAINEL) Study was derived from the Frailty among Brazilian Older Adults (FIBRA) Network Study. Data were collected through face-to-face/telephone interviews and clinical examination. A series of logistic regressions assessed associations between a recent history of disabling LBP and sociodemographic, physical/lifestyle, and psychological factors. RESULTS: Of the 378 community-dwelling elders included in the study (age±SD, 75.5±6.1), 9.3% experienced LBP that was bad enough to limit or change their daily activities during the past year. Those reporting a recent history of disabling LBP were more likely to be women and under financial strain, to present poor self-rated health, overweight, multimorbidity, low physical activity level, fatigue, depressive symptomatology/diagnosis and fear beliefs, and to report decreased sleep time, prolonged sitting time, chronic pain (in location other than lower back), and frequently recurring LBP. The multivariate logistic regression analysis indicated that overweight (odds ratio [OR], 29.6; 95% confidence interval [CI], 2.3-391.0), low physical activity level (OR, 4.4; 95% CI, 1.3-15.4), fatigue (OR, 10.3; 95% CI, 2.4-43.4), depression diagnosis (OR, 4.9; 95% CI, 1.3-18.4), and frequently recurring LBP (OR, 4.6; 95% CI, 1.0-20.1) were independently associated with a recent history of disabling LBP. DISCUSSION: Our study supports the link between disabling LBP and other age-related chronic conditions in a middle-income country with a rapidly aging population.

Factors associated with attitudes and beliefs of elders with acute low back pain: data from the study Back Complaints in the Elders (BACE)

ABSTRACT Background The attitudes and beliefs that older people have about acute low back pain (LBP) may influence the coping mechanisms and the adoption of treatment strategies in this population. Objective The aim of this study was to identify the factors associated with the attitudes and beliefs of elderly patients with acute low back pain using the Back Beliefs Questionnaire. Method This is a cross-sectional study with a subsample of the study “Back Complaints in the Elders” (BACE), composed of 532 older Brazilians of both genders with acute LBP. We investigated sociodemographic and clinical aspects, self-perceived health, psychosocial and emotional state, falls, and functional capacity. Multiple regression models were constructed to measure possible associations. Results The percentage of female participants was 85.7% and the mean age was 69.04 (SD=6.2). Disability, symptoms of depression, and expectation of return to activities were independently associated with attitudes and beliefs concerning LBP. Conclusion Screening of psychosocial factors is essential to the prevention of persistent and recurrent LBP. Early signs of these factors can help identify symptoms and behaviors for effective interventions.

Factors associated with attitudes and beliefs of elders with acute low back pain: data from the study Back Complaints in the Elders (BACE).

Background: The attitudes and beliefs that older people have about acute low back pain (LBP) may influence the coping mechanisms and the adoption of treatment strategies in this population. Objective: The aim of this study was to identify the factors associated with the attitudes and beliefs of elderly patients with acute low back pain using the Back Beliefs Questionnaire. Method: This is a cross-sectional study with a subsample of the study "Back Complaints in the Elders" (BACE), composed of 532 older Brazilians of both genders with acute LBP. We investigated sociodemographic and clinical aspects, self-perceived health, psychosocial and emotional state, falls, and functional capacity. Multiple regression models were constructed to measure possible associations. Results: The percentage of female participants was 85.7% and the mean age was 69.04 (SD=6.2). Disability, symptoms of depression, and expectation of return to activities were independently associated with attitudes and beliefs concerning LBP. Conclusion: Screening of psychosocial factors is essential to the prevention of persistent and recurrent LBP. Early signs of these factors can help identify symptoms and behaviors for effective interventions.

Prospective monitoring and self-report of previous falls among older women at high risk of falls and fractures: a study of comparison and agreement.

BACKGROUND: The identification of the occurrence of falls is an important step for screening and for rehabilitation processes for the elderly. The methods of monitoring these events are susceptible to recording biases, and the choice of the most accurate method remains challenging. OBJECTIVES: (i) To investigate the agreement between retrospective self-reporting and prospective monitoring of methods of recording falls, and (ii) to compare the retrospective self-reporting of falls and the prospective monitoring of falls and recurrent falls over a 12-month period among older women at high risk of falls and fractures. METHOD: A total of 118 community-dwelling older women with low bone density were recruited. The incidence of falls was monitored prospectively in 116 older women (2 losses) via monthly phone calls over the course of a year. At the end of this monitoring period, the older women were asked about their recall of falls in the same 12-month period. The agreement between the two methods was analyzed, and the sensitivity and specificity of self-reported previous falls in relation to the prospective monitoring were calculated. RESULTS: There was moderate agreement between the prospective monitoring and the retrospective self-reporting of falls in classifying fallers (Kappa = 0.595) and recurrent fallers (Kappa = 0.589). The limits of agreement were 0.35 ± 1.66 falls. The self-reporting of prior falls had a 67.2% sensitivity and a 94.2% specificity in classifying fallers among older women and a 50% sensitivity and a 98.9% specificity in classifying recurrent fallers. CONCLUSION: Self-reporting of falls over a 12-month period underestimated 32.8% of falls and 50% of recurrent falls. The findings recommend caution if one is considering replacing monthly monitoring with annual retrospective questioning.

Prospective monitoring and self-report of previous falls among older women at high risk of falls and fractures: a study of comparison and agreement

Background: The identification of the occurrence of falls is an important step for screening and for rehabilitation processes for the elderly. The methods of monitoring these events are susceptible to recording biases, and the choice of the most accurate method remains challenging. Objectives: (i) To investigate the agreement between retrospective self-reporting and prospective monitoring of methods of recording falls, and (ii) to compare the retrospective self-reporting of falls and the prospective monitoring of falls and recurrent falls over a 12-month period among older women at high risk of falls and fractures. Method: A total of 118 community-dwelling older women with low bone density were recruited. The incidence of falls was monitored prospectively in 116 older women (2 losses) via monthly phone calls over the course of a year. At the end of this monitoring period, the older women were asked about their recall of falls in the same 12-month period. The agreement between the two methods was analyzed, and the sensitivity and specificity of self-reported previous falls in relation to the prospective monitoring were calculated. Results: There was moderate agreement between the prospective monitoring and the retrospective self-reporting of falls in classifying fallers (Kappa=0.595) and recurrent fallers (Kappa=0.589). The limits of agreement were 0.35±1.66 falls. The self-reporting of prior falls had a 67.2% sensitivity and a 94.2% specificity in classifying fallers among older women and a 50% sensitivity and a 98.9% specificity in classifying recurrent fallers. Conclusion: Self-reporting of falls over a 12-month period underestimated 32.8% of falls and 50% of recurrent falls. The findings recommend caution if one is considering replacing monthly monitoring with annual retrospective questioning. .

Intra and inter-rater reliability study of pelvic floor muscle dynamometric measurements.

OBJECTIVE: The aim of this study was to evaluate the intra and inter-rater reliability of pelvic floor muscle (PFM) dynamometric measurements for maximum and average strengths, as well as endurance. METHOD: A convenience sample of 18 nulliparous women, without any urogynecological complaints, aged between 19 and 31 (mean age of 25.4 ± 3.9) participated in this study. They were evaluated using a pelvic floor dynamometer based on load cell technology. The dynamometric evaluations were repeated in three successive sessions: two on the same day with a rest period of 30 minutes between them, and the third on the following day. All participants were evaluated twice in each session; first by examiner 1 followed by examiner 2. The vaginal dynamometry data were analyzed using three parameters: maximum strength, average strength, and endurance. The Intraclass Correlation Coefficient (ICC) was applied to estimate the PFM dynamometric measurement reliability, considering a good level as being above 0.75. RESULTS: The intra and inter-raters' analyses showed good reliability for maximum strength (ICC(intra-rater1)=0.96, ICC(intra-rater2)=0.95, and ICC(inter-rater)=0.96), average strength (ICC(intra-rater1)=0.96, ICCi(ntra-rater2)=0.94, and ICC(inter-rater)=0.97), and endurance (ICC(intra-rater1)=0.88, ICC(intra-rater2)=0.86, and ICC(inter-rater)=0.92) dynamometric measurements. CONCLUSIONS: The PFM dynamometric measurements showed good intra- and inter-rater reliability for maximum strength, average strength and endurance, which demonstrates that this is a reliable device that can be used in clinical practice.

Intra and inter-rater reliability study of pelvic floor muscle dynamometric measurements

OBJECTIVE: The aim of this study was to evaluate the intra and inter-rater reliability of pelvic floor muscle (PFM) dynamometric measurements for maximum and average strengths, as well as endurance. METHOD: A convenience sample of 18 nulliparous women, without any urogynecological complaints, aged between 19 and 31 (mean age of 25.4±3.9) participated in this study. They were evaluated using a pelvic floor dynamometer based on load cell technology. The dynamometric evaluations were repeated in three successive sessions: two on the same day with a rest period of 30 minutes between them, and the third on the following day. All participants were evaluated twice in each session; first by examiner 1 followed by examiner 2. The vaginal dynamometry data were analyzed using three parameters: maximum strength, average strength, and endurance. The Intraclass Correlation Coefficient (ICC) was applied to estimate the PFM dynamometric measurement reliability, considering a good level as being above 0.75. RESULTS: The intra and inter-raters' analyses showed good reliability for maximum strength (ICCintra-rater1=0.96, ICCintra-rater2=0.95, and ICCinter-rater=0.96), average strength (ICCintra-rater1=0.96, ICCintra-rater2=0.94, and ICCinter-rater=0.97), and endurance (ICCintra-rater1=0.88, ICCintra-rater2=0.86, and ICCinter-rater=0.92) dynamometric measurements. CONCLUSIONS: The PFM dynamometric measurements showed good intra- and inter-rater reliability for maximum strength, average strength and endurance, which demonstrates that this is a reliable device that can be used in clinical practice. .

Influence of dual task and frailty on gait parameters of older community-dwelling individuals.

BACKGROUND: Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology. OBJECTIVE: To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS. METHOD: The presence of frailty was verified by Fried's Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(®) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson's Correlation tests were administered. RESULTS: The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001). CONCLUSIONS: Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population.

Influence of dual task and frailty on gait parameters of older community-dwelling individuals

Background: Gait parameters such as gait speed (GS) are important indicators of functional capacity. Frailty Syndrome is closely related to GS and is also capable of predicting adverse outcomes. The cognitive demand of gait control is usually explored with dual-task (DT) methodology. Objective: To investigate the effect of DT and frailty on the spatio-temporal parameters of gait in older people and identify which variables relate to GS. Method: The presence of frailty was verified by Fried's Frailty Criteria. Cognitive function was evaluated with the Mini-Mental State Exam (MMSE) and gait parameters were analyzed through the GAITRite(r) system in the single-task and DT conditions. The Kolmogorov-Smirnov, ANOVA, and Pearson's Correlation tests were administered. Results: The participants were assigned to the groups frail (FG), pre-frail (PFG), and non-frail (NFG). During the DT, the three groups showed a decrease in GS, cadence, and stride length and an increase in stride time (p<0.001). The reduction in the GS of the FG during the DT showed a positive correlation with the MMSE scores (r=730; p=0.001) and with grip strength (r=681; p=0.001). Conclusions: Gait parameters are more affected by the DT, especially in the frail older subjects. The reduction in GS in the FG is associated with lower grip strength and lower scores in the MMSE. The GS was able to discriminate the older adults in the three levels of frailty, being an important measure of the functional capacity in this population. .

Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study.

BACKGROUND: Frailty and sarcopenia are frequent conditions in the elderly and are related to inactivity and functionality. However, little is known about the influence of the sarcopenia indicators on the frailty profile or their functional implications. OBJECTIVE: To evaluate whether the indirect indicators of sarcopenia and functionality influence the frailty profile in elderly subjects. METHOD: This was a cross-sectional study with 53 elderly subjects recruited by an active search in a secondary health care service. The indirect indicators of sarcopenia were body mass index (BMI), gait speed, Mini-Nutritional Assessment (MNA), Human Activity Profile (HAP), and handgrip strength. Frailty was characterized according to Fried's Frailty Phenotype. Functional capacity was assessed according to the Short Physical Performance Battery (SPPB). Physical activity level was assessed by HAP. Data were analyzed by analysis of variance (ANOVA) and multiple regression. RESULTS: Overall, 75.5% of the subjects were women, with a mean age of 76.72 (±5.89) years; 15.1% were frail and 54.7% pre-frail; and the level of physical activity was the most prevalent indicator of sarcopenia. Significant differences (p<0.05) were observed in both the physical activity level and gait speed between the non-frail and pre-frail groups and between the non-frail and frail groups. In addition, some sarcopenia indicators were associated with functional capacity and geriatric depression score. CONCLUSION: The level of physical activity and gait speed appeared to be the most relevant factors in the development of frailty in the study sample, which may have functional implications.

Functional and cognitive changes in community-dwelling elderly: longitudinal study.

BACKGROUND: The relationship between aging and increased life expectancy in the overall population likely contributes to a higher frequency rate and incidence of illnesses and functional disabilities. Physical dependence and cognitive impairment might hinder the performance of activities and result in an overload of care duties for the patient's family and the healthcare system. OBJECTIVE: The aim of this study was to compare the functional and cognitive changes exhibited by the elderly over a 6-month period. METHOD: This longitudinal and observational study was conducted in a sample of 167 elderly people, who were selected from the database of the Network of Studies on Frailty in Brazilian Elderly, Universidade Federal de Minas Gerais - UFMG. The participants submitted to the Mini Mental State Examination (MMSE), Katz Index, Lawton and Brody's scale and responded to items on Advanced Activities of Daily Living (AADLs). We analyzed the data using multivariate regression models. RESULTS: The participants' functional capacity exhibited reduced performance of specific instrumental activities of daily living (IADLs), p=0.002, and basic activities of daily living (BADLs), p=0.038. Living alone (odds ratio (OR), 2.53; 95% confidence interval (CI), 1.09-5.87) and work status (OR, 2.52; 95% CI, 1.18-5.41) were associated with changes in the IADLs. The scores in the AADL scale (p=0.163) and MMSE (p=0.059) did not exhibit any significant difference during the study period. The participants with better cognitive function were more independent in their performance of AADLs and IADLs. CONCLUSION: The results depict specific patterns of loss and stability of functional capacity in community-dwelling elderly.

Influence of sarcopenia and functionality indicators on the frailty profile of community-dwelling elderly subjects: a cross-sectional study

BACKGROUND: Frailty and sarcopenia are frequent conditions in the elderly and are related to inactivity and functionality. However, little is known about the influence of the sarcopenia indicators on the frailty profile or their functional implications. OBJECTIVE: To evaluate whether the indirect indicators of sarcopenia and functionality influence the frailty profile in elderly subjects. METHOD : This was a cross-sectional study with 53 elderly subjects recruited by an active search in a secondary health care service. The indirect indicators of sarcopenia were body mass index (BMI), gait speed, Mini-Nutritional Assessment (MNA), Human Activity Profile (HAP), and handgrip strength. Frailty was characterized according to Fried's Frailty Phenotype. Functional capacity was assessed according to the Short Physical Performance Battery (SPPB). Physical activity level was assessed by HAP. Data were analyzed by analysis of variance (ANOVA) and multiple regression. RESULTS: Overall, 75.5% of the subjects were women, with a mean age of 76.72 (±5.89) years; 15.1% were frail and 54.7% pre-frail; and the level of physical activity was the most prevalent indicator of sarcopenia. Significant differences (p<0.05) were observed in both the physical activity level and gait speed between the non-frail and pre-frail groups and between the non-frail and frail groups. In addition, some sarcopenia indicators were associated with functional capacity and geriatric depression score. CONCLUSION: The level of physical activity and gait speed appeared to be the most relevant factors in the development of frailty in the study sample, which may have functional implications. .

Functional and cognitive changes in community-dwelling elderly: Longitudinal study / Mudancas funcionais e cognitivas em idosos da comunidade: estudo longitudinal

BACKGROUND: The relationship between aging and increased life expectancy in the overall population likely contributes to a higher frequency rate and incidence of illnesses and functional disabilities. Physical dependence and cognitive impairment might hinder the performance of activities and result in an overload of care duties for the patient's family and the healthcare system. OBJECTIVE: The aim of this study was to compare the functional and cognitive changes exhibited by the elderly over a 6-month period. METHOD: This longitudinal and observational study was conducted in a sample of 167 elderly people, who were selected from the database of the Network of Studies on Frailty in Brazilian Elderly, Universidade Federal de Minas Gerais - UFMG. The participants submitted to the Mini Mental State Examination (MMSE), Katz Index, Lawton and Brody's scale and responded to items on Advanced Activities of Daily Living (AADLs). We analyzed the data using multivariate regression models. RESULTS: The participants' functional capacity exhibited reduced performance of specific instrumental activities of daily living (IADLs), p=0.002, and basic activities of daily living (BADLs), p=0.038. Living alone (odds ratio (OR), 2.53; 95% confidence interval (CI), 1.09-5.87) and work status (OR, 2.52; 95% CI, 1.18-5.41) were associated with changes in the IADLs. The scores in the AADL scale (p=0.163) and MMSE (p=0.059) did not exhibit any significant difference during the study period. The participants with better cognitive function were more independent in their performance of AADLs and IADLs. CONCLUSION: The results depict specific patterns of loss and stability of functional capacity in community-dwelling elderly. .

CONTEXTUALIZAÇÃO: O processo de envelhecimento associado à ampliação da expectativa de vida da população pode acarretar um aumento da prevalência e incidência de doenças e de prejuízos à funcionalidade. A dependência física e o comprometimento cognitivo podem impedir o desempenho de atividades, gerando uma sobrecarga de cuidados para a família e para o sistema de saúde. OBJETIVO: Comparar as mudanças funcionais e cognitivas em idosos ocorridas num período de seis meses. MÉTODO: Trata-se de um estudo observacional longitudinal, com uma amostra de 167 idosos, selecionados a partir do banco de dados da Rede de Estudos da Fragilidade em Idosos Brasileiros do polo da Universidade Federal de Minas Gerais (UFMG). Os participantes responderam ao Miniexame do Estado Mental (MEEM), ao Índice de Katz, a Escala de Lawton e Brody e a questões relativas à Atividade Avançada de Vida Diária (AAVD). Os dados foram analisados com modelos de regressão multivariada. RESULTADOS: Observou-se diminuição da capacidade funcional nas Atividades Instrumentais de Vida Diária (AIVD), p=0,002, e, nas Atividades Básicas de Vida Diária (ABVD), p=0,038, em algumas atividades específicas. Morar sozinho (OR=2,53; IC=1,09:5,87) e condição de trabalho (OR=2,52; IC=1,18:5,41) associaram-se a mudança nas AIVD. Não houve diferença significativa no período de tempo do acompanhamento, na pontuação da AAVD, p=0,163, e do MEEM, p=0,059. Observou-se que os indivíduos com melhor cognição eram mais independentes nas AAVD e nas AIVD. CONCLUSÃO: Esses resultados revelam perfis específicos de perda e de estabilidade na funcionalidade de idosos comunitários. .